Individual
DR. KEVIN SCOTT BODKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4900 BROADWAY, GARY, IN 46408-4605
(419) 696-6000
(419) 696-6018
Mailing address
4900 BROADWAY, GARY, IN 46408-4605
(219) 237-5170
(219) 321-1931
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02005742A
IN
207Q00000X
Family Medicine Physician
34009615
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2996530
—
OH
Enumeration date
07/30/2008
Last updated
02/18/2020
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